Description

RESPONSIBILITY:

• Collaborate with leadership, identify appropriate contracting and re-contracting opportunities.
• Initiates discussions with key constituents as related to new relationships or service lines.
• Performs business and market analysis to determine viability of contracting.
• Ensures contracting efforts remain aligned with company goals; contract terms can be administered and monitored in a cost-effective manner.
• Collaborates with payors and internal stakeholders to gain a thorough understanding of payer-specific requirements, reimbursement logic and limitations.
• Leads contract discussions with managed care organizations, including rate and language negotiations in accordance with established guidelines. Leads development of rate and language proposals.
• Collaborates with internal staff on modeling of rate proposals.
• Confidently make sound recommendations to leadership for accepting/rejecting proposed managed care agreements.
• Effectively interfaces with management, clinical, operations, and administrative staff to ensure contract negotiations are completed in accordance with critical dates and within approved financial parameters.
• Manages all aspects of the contract life-cycle; reviews and evaluates contract language and reimbursement terms.
• Updates and models with new contract and reimbursement terms using proprietary software applications and MS Office tools.
• Collaborates to assemble and gain an understanding of payer specific data, operational issues, and business review.
• Prepares financial analyses and reports.
• Implements executed contracts cross-functionally, communicates contract changes internally, maintains appropriate documentation, reviews contract performance reports and makes appropriate recommendations.
• Facilitates problem solving of escalated contractual and operational issues through collaboration with managed care organizations and internal stakeholders.
• Identifies and communicates opportunities for process improvement with managed care organizations and internal stakeholders.
• Coordinates with analytical team to ensure contractual terms, including payer-specific requirements, reimbursement logic, and limitations are understood and appropriately included in any modeling systems.
• Serves as the expert on all terms of the payer contract for both internal and external parties.
• Participates in special projects as needed, including evaluating feasibility of program development as it pertains to payer operational requirements and reimbursement policies
• Stays abreast of changing healthcare landscape to maintain an awareness of competitor services and reimbursement models, as well as opportunities for improvement in the financial and operational components of managed care contracts.
• Leads discussions pertinent to contract performance, market changes, market intelligence, and strategic decision making.
• Performs miscellaneous job related duties as requested.